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2025 Anesthesia > Exam 3: Lecture 24 - CV Support Drugs & Basic CPR > Flashcards

Exam 3: Lecture 24 - CV Support Drugs & Basic CPR Flashcards

1
Q

___ is a major anesthetic complication

A

Hypotension
-Reported in 20-30% of dogs and cats having elective procedures, but probably occurs more often

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2
Q

Where do you want to keep the MAP and SAP?

A

-Keep MAP > 60-70 mmHg
-SAP > 80-90 mmHg

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3
Q

What are common causes of CV depression during anesthesia?

A
  1. Drugs
  2. Equipment malfunction/misuse
  3. Shock/sepsis
  4. Hypovolemia
  5. Mechanical ventilation
  6. Surgical procedure
  7. Pre-existing CV disease
  8. Metabolic disease
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4
Q

What is the key with CV depression during anesthesia?

A

-Key is to treat the underlying cause of hypotension

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5
Q

What does MAP encompass?

A

-Heart rate
-Stroke volume
-Systemic vascular resistance

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6
Q

CO =

A

HR x SV

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7
Q

What is cardiac output (CO)?

A

Volume heart is pumping out in L/min

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8
Q

Map = (about)

A

CO x SV

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9
Q

What big picture thing so we care about with CV support?

A

-Oxygen delivery to the tissues

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10
Q

What are the mechanisms to managing hypotension?

A

-Adjustment to current anesthetic management
-Fluids
-Anticholinergics
-Vasopressors
-Positive inotropes

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11
Q

What are cardiovascular support drugs?

A

-Positive inotropes
-Vasopressors

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12
Q

The cardiovascular support drugs (positive inotropes & vasopressors) act as ____ and what does that mean?

A

-Act as sympathomimetics
-Means mimic the sympathetic side of the nervous system (increasing contractility or squeezing of peripheral vasculature)

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13
Q

What are sympathomimetics?

A

-Includes endogenous catecholamines (ex: epinephrine, NE, dopamine), synthetic catecholamines (dobutamine), and synthetic non-catecholamines (phenylephrine)

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14
Q

Relative selectivity of sympathomimetics for various adrenergic receptors depends on

A

-The chemical structure of the drug
-They act on a- adrenergic, b-adrenergic, or dopaminergic receptors directly or indirectly & these receptors are coupled to G protein
-The density of a & b-adrenergic receptors in tissue determines the response of the drug

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15
Q

What to you need to understand in order to understand what the CV support drugs do?

A

-Understand the receptors they work on and what organ systems they have their effect on

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16
Q

Where are alpha-1 receptors located and what is their action?

A

-Located: vascular smooth m.
-Action: increase vascular smooth m. contraction

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17
Q

Where are alpha-2 receptors located and what is their action?

A

-Located: CNS
-Action: Decrease sympathetic outflow

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18
Q

Where are beta-1 receptors located and what is their action?

A

-Located: Cardiac cells
-Action: Increase heart rate, increase contractility, increase renin release

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19
Q

Where are beta-2 receptors located and what is their action?

A

-Located: Vascular & bronchiolar smooth m.
-Action: Vasodilation, bronchodiation

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20
Q

Where are D-1 receptors located and what is their action?

A

-Located: Renal, splanchnic, coronary, cerebral
-Action: Relaxes renal vasculature smooth m.

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21
Q

What does Dobutamine act on & cause?

A

-Mostly beta-1
-positive inotropic effects leading to dose-dependent increase in myocardial contractility, SV, & CO

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22
Q

How is Dobutamine typically administered for hypotension?

A

-Typical CRI dose used for treatment of hypotension in small animals

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23
Q

What is important about CRI’s?

A

-Cannot just pull it out of the bottle & use it!

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24
Q

What is Dopamine and how does it work?

A

-Endogenous catecholamine that is precursor to norepinephrine
-Acts directly & indirectly on both alpha and beta-1 receptors
-Also as dopaminergic (D1, D2) effects
-Increases CO; modest increase in HR, BP, & SVR

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25
What are the indications for using Dopamine?
-Treatment of acute heart failure, severe hypotension or shock
26
What effects are seen with lower doses of Dopamine?
-At lower doses, D1 & D2 effects include dilation of renal, mesenteric, coronary, and intercerebral vascular beds
27
What effects are seen with higher doses of Dopamine?
-At higher doses, there is an increase systemic peripheral resistance due to mainly alpha 1 receptor effects
28
Dopamine should begin to work within
5 minutes
29
What is Ephedrine and how is it used?
-Mixed inotropic-pressor agonist at a1, a2, b1 and b2 receptors -Commonly used for management of hypotension during general anesthesia in horses b/c can be given as bolus instead of CRI (due to longer duration of action compared to other CV support drugs)
30
What species is Ephedrine typically used in?
-Horses
31
How does Norepinephrine work?
Agonist at the a1, a2, b1 receptors -Equal in potency to epinephrine for stimulation of b1, but little effect on b2 -Potent a-agonist that produces **intense** arterial & venous vasoconstriction in all vascular beds -Tends to decrease CO & may cause metabolic acidosis
32
What can happen with Norepinephrine?
-Necrosis if extravasation occurs
33
How is Norepinephrine typically administered?
-Mainly used as CRI for treatment of refractory hypotension due to vasodilation from inhalant anesthesia or sepsis b/c effects are mostly on a1 receptor at the clinically used dose rate
34
How does Epinephrine work?
Has both vasopressor & inotropic effects by directly stimulating a1, b1, and b2 receptors & is **most potent activator** of a-adrenergic receptors -a1: intense vasoconstriction (of periphery; skin, mucosa etc.) -b1 effects: increase SAP, HR, CO -b2 effects: modest decrease in DAP due to vasodilation in skeletal m., bronchodilatio
35
What is the net effect of Epinephrine?
-Increase in pulse pressure & minimal change in MAP -Preferential distribution of CO to skeletal m. & decreased SCR -Renal blood flow decreases, but coronary blood flow increases -Secretion of renin due to b stimulation in the kidneys
36
How is Epinephrine given?
-Typically reserved for use as a bolus during CPR -Can be given as a CRI as a last resort for treatment of severe hypotension due to endotoxemia
37
What is Phenylephrine and how does it work?
-Increases peripheral vascular resistance by agonist effects on the a1 receptors & can be used in patients w/ severe vasodilation (e.g. due to septic shock)
38
When should Phenylephrine be avoided?
-Generally recommended to avoid the use of phenylephrine to pregnant patients as it decreases blood flow to the uterus & therefore impairs oxygen delivery to the fetus
39
How does Vasopressin work?
Works through stimulation of V1 receptor located on vascular smooth m. -Unique feature of V1 receptors is ability to remain responsive during periods of acidosis (unlike a1 receptors) -Has no inotropi or chronotropic effects
40
What patients is Vasopressin indicated in?
-For vasodilatory hypotension due to sepsis, prolonged hemorrhagic shock, or cardiac arrest
41
How is Vasopressin given?
During CPR, vasopressin boluses can be substituted for epinephrine -Can do CRI dose for vasodilatory shock due to sepsis ranges from 0.5-2.0 mU/kg/min in dogs
42
How do you get a CRI to use?
-Have to make it yourself
43
What are the (basic) steps for making a CRI?
-Has to be diluted -Know what drugs it is compatible with -Come up with dose and can either have a way to deliver them, or can have them free drip -Don't mix up too far in advance for a case b/c only good for 24 hours once mixed
44
____ are 5x more likely to survive to hospital discharge after CPR than ____
Cats than dogs
45
Anesthetic related CPA events are almost ____ more likely to be discharged compared to other groups
15x
46
What are the RECOVER guidelines?
-**Re**assessment **C**ampaign **o**n **Ve**terinary **R**esuscitation Goals: -Review of literature -Develop consensus on CPR guidelines -Provide education & training for veterinary medical care team
47
What is the "chain of survival" when talking about CPR?
-Prevention/early recognition -Basic life support (BLS) -Advanced life support (ALS) -Post Resuscitation Care (aka post cardiac arrest care)
48
What are the signs of cardiopulmonary arrest?
-Not responsive -Not breathing -No pulse detected
49
What are the 3 components of BLS?
(BLS = Basic Life Support) 1. Shake & shout (i.e. provide stimulation) 2. If not breathing/responsive, immediately start chest compressions @ 100-120 per min. & depth of 1/3 to 1/2 chest width. **Do not stop to check pulse for 2 minutes!** 3. Establish airway & ventilate at 10 bpm (i.e. give breath every 6 seconds)
50
T/F there is a CPR app
TRUE! There is a recover CPR app
51
What does the RECOVER CPR app provide?
-Free to download & use -Serves as metronome to guide compression & ventilation timing -Keeps track of 2-minute cycles -Records all drugs given -A PDF record can be sent afterwards
52
What is the position of the patient for chest compressions?
-Lateral recumbency
53
What is the position of the compressor for chest compressions?
-Stand behind the patient (along the spine)
54
What is the hand position for the compressor for chest compressions?
-Hand over hand, interlaced fingers
55
What is the compressor stance for chest compressions?
-Shoulders over elbows/hands, lock elbows, bend at the waist
56
What are some ways we can make chest compressions easier for the compressor?
-Use a stool if needed -Can put patient on the floor -Or you can get on the table
57
What are the patient chest types?
A. Large, round chest B. Large, keel chest C. Wide-chest (e.g. Bulldogs) D. Cats & small dog breeds
58
How do chest compressions change when you have a wide-chested dog like a Bulldog?
-Dorsal recumbency -Compress to 25% depth
59
How does the hand position change when you have a cat or small dog breed?
-Circumferential -One-handed palm -One-handed thumb-to-fingers
60
What airways & ventilation can we use during CPR?
-Ideally intubated w/ appropriately sized ET tube w/ cuff inflated & tube secured in place -Alternatively, use tight-fitting mask & self-inflating bag to deliver breaths -Use of 100% O2 reasonable -If not able to intubate, can go mouth-to-snout (if no concern for infectious disease or narcotic exposure) using ratio of 30 compressions to 2 ventilation technique
61
What is an example of a manual resuscitator we can use during CPR?
-Ambu bag
62
What should we do during the 2-minute cycle of compressions & ventilation (first 2 most important)
1. Hook up ECG leads 2. Place capnograph (ETCO2) at the end of the ETT 3. Gain IV access -IO would be 2nd choice -Some drugs can go IT if no other access available (inter-trachially) 4. Administer reversal agents if indicated -NO cardiac sticks!
63
How should the "pause and check" phase of CPR be completed?
-Take no more than **10 seconds** to stop compressions long enough to feel for femoral pulse & team assesses hooked up ECG -If a pulse -> ROSC -If no pulse: evaluate ECG to determine if shockable or non-shockable rhythm, evaluate ETCO2 (if **<18 mmHg**, evaluate quality of compressions)

2025 Anesthesia (29 decks)

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